Arkansas Issue 3 (2024) — The Medical-Expansion Measure the Court Wouldn’t Let Voters Decide

Last verified: May 2026

What Issue 3 Would Have Done

Arkansans for Patient Access (with Bill Paschall as petition representative and David Couch as drafting attorney) drafted the Arkansas Medical Marijuana Amendment of 2024. The proposed amendment would have:

• Allowed home cultivation by qualifying patients — ending Amendment 98 § 6(b)’s ban.
• Expanded certifying providers to include physician assistants (PAs) and nurse practitioners (NPs) — ending the M.D.-and-D.O.-only restriction.
• Removed the 18-condition list — allowing certifying providers to recommend cannabis for any condition they reasonably believed cannabis could treat.
• Contained a federal-trigger provision — automatically legalizing adult use upon any federal cannabis rescheduling.
• Added "Tier 2" small-cultivator licenses to the 8-cultivator cap.
• Allowed each existing licensee one additional retail location.

The 150,335-Signature Submission

Arkansans for Patient Access submitted 150,335 signatures to the Arkansas Secretary of State in mid-2024. The threshold for a citizen-initiated constitutional amendment is approximately 90,704 signatures (10% of votes cast for governor in the most recent gubernatorial election), so the submission was substantially over the legal threshold.

The Secretary of State’s office initially certified the petition signatures, but several anti-Issue-3 challenges immediately followed in court — including challenges to the ballot title’s phrasing and to the canvasser-verification process.

The Arkansas Supreme Court Ruling

On October 21, 2024, just two weeks before the November 5, 2024 general election, the Arkansas Supreme Court ruled 4–3 that the Issue 3 ballot title was "misleading" and enjoined the Secretary of State from canvassing or certifying votes on the measure. Issue 3 still appeared on the November 2024 ballot — it was too late to remove it — but votes for and against were not counted.

The Two Sanders-Appointed Special Justices

A defining structural feature of the Issue 3 ruling: two members of the 4-justice majority were special justices appointed by Governor Sarah Huckabee Sanders for the case, in lieu of recused regular justices. The 4-3 vote split would not have existed without the special justices — meaning the ballot measure was effectively blocked by Governor-Sanders-appointed jurists ruling on a measure Sanders herself had publicly opposed.

The structural critique — that the executive’s power to appoint special justices became a tool for the executive to defeat a citizen-initiated constitutional amendment the executive opposed — was raised loudly by Issue 3 supporters and by some Arkansas legal scholars.

The Three-Justice Dissent

The three-justice dissent (Justices Karen Baker, Rhonda Wood, and one of the Sanders-appointed special justices, who broke with the other Sanders-appointed special justice) argued that:

• The ballot title’s descriptive language was within the range of typical citizen-initiated ballot measures.
• The Court’s readiness to enjoin a measure that had cleared signature thresholds at the very tail end of the election cycle invited future similar judicial pre-emptions of citizen initiatives.
• Voters should have been allowed to render their judgment, with any subsequent legal challenges to the measure’s constitutional validity addressed through normal post-passage litigation.

The Aftermath

• Issue 3 received votes on the ballot on November 5, 2024, but no certified vote total exists.
• Estimated based on pre-election polling and partial early-vote data, Issue 3 likely received between 45% and 55% Yes — the directional indicator was uncertain but more favorable than Issue 4’s 43.75%.
• The decision was widely viewed within the Arkansas legal community as setting a new, lower bar for ballot-title invalidation by the courts.
• Citizen-initiative reforms became a parallel project — the Save AR Democracy amendment was conceived in 2025 to restore some signature-process protections, ultimately failing to qualify for 2026.

The David Couch Legal Architecture

David Couch, the Little Rock attorney who drafted Amendment 98 in 2016, also drafted Issue 3 in 2024. Couch had been the principal architect of every successful Arkansas medical-cannabis legal-and-political development from 2014 through 2019. The Issue 3 setback marked the most significant loss of Couch’s career as a cannabis-policy attorney. As of May 2026, Couch’s law firm continues to advocate for medical-program expansion through legislative channels, having largely set aside the citizen-initiative path after Issue 3.

What 2024 Cost the Patient Access Coalition

• Estimated $4–6 million spent by Arkansans for Patient Access on the campaign.
• ~150,000 voter signatures collected and rendered legally moot by the Court’s ruling.
• The "next ballot" cycle — effectively pushed to 2028, since 2026 will not have a measure (Save AR Democracy fell short of signatures).
• The institutional credibility cost of having put a measure on the ballot only to have it legally voided.

Related on this site: Arkansas Edgmon Reversal (Dec 2025) &..., Arkansas Issue 4 (2022), Arkansas Cannabis Politicians.